Who develops abnormally invasive placenta during pregnancy?

We will discuss “Abnormally invasive placenta – Prevalence, risk factors and antenatal suspicion: Results from a large population-based pregnancy cohort study in the Nordic Countries” by Thurn and co-workers from 30 September 2015 for 7 days.

*This paper will be made FREE-TO-VIEW on 21 September 2015.

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Start date: 30 September 2015 (the discussion will open for 7 days between 30 September to 7 October 2015)

First hosted discussion session(s) starts at: BST 7pm (UK time)

Host: @BlueJCHost

Platforms: Twitter and LinkedIn

BJOG_BlueJC_160x600WebBanner_Mar15_(reoriented)_3The Blue Journal Club is an international journal club on women’s health research based on Twitter (as @BlueJCHost). We start our conversation on the last Wednesday of every month and use the hashtag #BlueJC for our tweets. Simply add this hashtag (“#BlueJC”) to each tweet and we will capture it. Each #BlueJC opens for 7 days with an advertised start time. All BJOG #BlueJC papers also have complementary slide sets suitable for face-to-face journal clubs with your local colleagues. You can access the slide set of this paper here (find the title paper and click on the “discussion point” tab).

The discussion points are attached below (quoted from the published manuscript)



A 32-year-old woman presents with small amount of vaginal bleeding at 26 weeks of her pregnancy. She has no other symptoms and is stable. She had two previous caesarean sections; for breech presentation in her first pregnancy and a subsequent elective caesarean section. Ultrasound assessment confirms the fetus is viable with normal growth. However, placenta is anterior and low-lying (placenta praevia). How would you manage this woman?

Description of research

Participants Women giving birth in the Nordic Countries between 2009-2012
Intervention Women with abnormally invasive placenta (AIP), with or without antenatal suspicion of AIP
Comparison The respective background population of each country (women without AIP)
Outcomes Prevalence, risk factors, antenatal suspicion, birth complications and risk estimations using aggregated national data.
Study design Population-based Cohort Study, the Nordic Obstetric Surveillance Study (NOSS)

Discussion Points

  • How do you define and diagnose abnormally invasive placenta (AIP)?
  • How common is AIP in your practice?
  • What is the Nordic Obstetric Surveillance Study (NOSS)?
  • What are the benefits of prospective registration of rare complications of pregnancy (compared to existing retrospective registration systems based on ICD-10 codes)?
  • What are the strengths and pitfalls of amalgamating data from multiple countries?
  • What are the major risk factors of AIP identified in this study? How much more likely are women with these risk factors to have AIP?
  • Is antenatal suspicion of AIP associated with improved maternal and neonatal outcomes?
  • Can you briefly summarise the results of this study in one sentence?
  • How would the results of this study influence your daily practice?
  • How can we develop an internationally agreed definition of AIP?

Suggested reading

  • Fitzpatrick KE, Sellers S, Spark P, Kurinczuk JJ, Brocklehurst P, Knight M. The management and outcomes of placenta accreta, increta, and percreta in the UK: a population-based descriptive study. BJOG. 2014 Jan;121(1):62-70; discussion 70-1.
  • Calì G, Giambanco L, Puccio G, Forlani F. Morbidly adherent placenta: evaluation of ultrasound diagnostic criteria and differentiation of placenta accreta from percreta. Ultrasound Obstet Gynecol. 2013 Apr;41(4):406-12.
  • Rustamov O, Alfirevic Z, Arora R, Siddiqui I, Mitchell AL. Imaging techniques for antenatal detection of morbidly adherent placenta (Protocol). Cochrane Database of Systematic Reviews 2011, Issue 2. Art. No.: CD008985.

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